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General NPI Number Information
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NPI Number | 1427212018
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Entity Type | Individual
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Provider Name | TONY LOUIS MINUTILLO D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 820 E TERRA COTTA AVE SUITE 111
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3649
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Country | US
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Telephone | 815-356-7960
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Fax | 815-356-8051
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Provider Business Mailing Address
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Address Line | 820 E TERRA COTTA AVE SUITE 111
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3649
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Country | US
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Telephone | 815-356-7960
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Fax | 815-356-8051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.022613
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License Number State | IL
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